12-month Success of Cracked Teeth Treated with Orthograde Root Canal Treatment.

INTRODUCTION: Long-term studies examining the treatment outcomes of "cracked teeth" that received orthograde root canal treatment in the United States do not exist. The purpose of the present study was to examine the distribution and 1-year treatment outcomes of cracked teeth receiving orthograde root canal treatment in 1 private endodontic practice over a 25-year period. METHODS: A total of 3038 cracked teeth were initially examined, and data from 2086 unique patients were analyzed. Pulpal and periapical diagnoses, year of treatment, tooth type, restorative material, and number of restored surfaces at the time of examination were recorded for all patients. Periodontal probing depths were also recorded. The patients' age and sex were added retrospectively for all patients whose data were available. Univariate frequency distributions for all collected variables were evaluated. Bivariate associations were analyzed between explanatory variables and the success of the root canal therapy. RESULTS: Of the 2086 cracked teeth observed among unique patients, the most common were mandibular second molars (36%) followed by mandibular first molars (27%) and maxillary first molars (18%). Among the 363 teeth eligible for multivariable regression analysis, 296 (82%) were deemed successes after 1 year. There were no statistically significant differences in success based on pulpal diagnosis (irreversible pulpitis, 85%; necrosis, 80%; previously treated, 74%), patients' age, sex, year of treatment, tooth type, restorative material, or number of restored surfaces at the time of examination. The 3 factors most significant in bivariate analyses were pocket depth, distal marginal ridge crack, and periapical diagnosis, which were used to generate a prognostic index for success of orthograde root canal therapy in cracked teeth called the Iowa Staging Index. CONCLUSIONS: The results of this study suggest that cracked teeth that received root canal treatment can have prognoses at higher success rates than previously reported. The Iowa Staging Index may prove to be useful in clinical treatment decision making.

Reparación de una fractura radicular horizontal media complicada mediante la impactación alveolar que impide su reposición: Revisión a los 21 años / Horizontal mid-root fracture healing with alveolar impactation: a 21 years recall

La fractura radicular horizontal media es una consecuencia de los traumatismos dentales que compromete el pronóstico del diente afectado. La situación clínica se complica cuando concurren condiciones asociadas que afectan a la vitalidad pulpar, la salud periodontal y la reposición del diente a su situación original. El caso descrito en este artículo presenta un incisivo superior derecho, con una fractura radicular horizontal media, complicada por la existencia de una impactación del fragmento coronal en la cortical externa. Esta implicación alveolar impide la reducción de los fragmentos del diente, por lo que se hizo necesario un levantamiento de un colgajo de espesor total para liberar el fragmento coronal de la cortical externa alveolar y reducir la fractura. Las revisiones posteriores muestran el mantenimiento de la vitalidad del incisivo afectado y la reparación a nivel de la línea de fractura con ausencia de patología periapical y perirradicular. Presentamos la situación clínica en la revisión del caso, transcurridos 21 años, donde se aprecia la salud de los tejidos afectados, la reparación de la fractura radicular horizontal y el mantenimiento de la respuesta positiva a la estimulación pulpar

The horizontal mid-root fracture is a clinical complication of dental trauma that compromises the prognosis of the injured tooth. The clinical situation is jeopardized by condition re/ated to vital pulp, periodontal health and repositioning of the fractured tooth in its original position. We report a case of a radicular horizontal fracture of an upper central incisor complicated by the impactaction of the coronal fragment in the external alveolar cortical bone. This alveolar implication prevents the fragments from reduction. A fuI/ thickness flap rises al/owed the liberation of coronal fragment and the reduction of the fracture. Fol/ow up evaluations showed the maintenance of the pulp vitality and the repair of the fracture with total absence of periapical and periradicular pathology. We report the clinical situation, after 21 years. The affected tissues are in good health, the fracture is repaired and the pulp maintains its vitality